Aizaz Saleem Khan, Waseem Afzal, Adnan Anwar.
Comparison of shoulder function, radial nerve palsy and infection after nailing versus plating in humeral shaft fractures.
J Coll Physicians Surg Pak Jan ;20(4):253-7.

Objective: To compare shoulder function, radial nerve palsy and infection after interlocking nailing with plating of fractures of shaft of humerus during 30 weeks of follow-up. Study Design: Experimental study. Place and Duration of Study: Orthopaedic Wards of Combined Military Hospital, Rawalpindi, from November 2006 to November 2008. Methodology: Two groups of 30 patients each were inducted. Group A (n=30) was treated with intramedullary interlocking nailing while Group B (n=30) underwent plating with dynamic compression plate (DCP). Shoulder function using ASES score, radial nerve palsy and infection were observed for 30 weeks. Results: In group A, 11 patients had severe or moderate shoulder dysfunction (ASES score below 39), out of whom 8 (72%) were above 50 years. This age related disability was significant (p=0.003). Transient palsy was observed in 3 patients (10%) and mild wound infection in 2 (6%), which was not associated with age or open fracture. In group B, only 1 patient had severe shoulder dysfunction, the difference was statistically significant between the two groups (p=0.001), especially in patients above 50 years of age. There was no statistical difference in infection and palsy rates between the two groups. Conclusion: Although nailing and plating are effective treatments for fractures of shaft of humerus, ante-grade nailing may not be suitable in elderly patients, as it can cause significant shoulder dysfunction.

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